Browsing by Author "Prabhu, M"
Now showing 1 - 7 of 7
Results Per Page
Sort Options
Publication A study on rational drug prescribing and dispensing in outpatients in a tertiary care teaching hospital of Western Nepal(kathmandu University, 2006) Alam, K; Mishra, P; Prabhu, M; Shankar, PR; Palaian, S; Bhandari, RB; Bista, DObjectives: To analyze the prescriptions of out-patients for rational prescribing and dispensing and to evaluate the patient’s knowledge regarding use of drugs, using INRUD indicators. Methods: A cross-sectional, descriptive study was conducted at the Manipal Teaching Hospital, Pokhara, Nepal during the time period from June 10 th to August 19 th 2004. Results: Totally 247 prescriptions were randomly selected for analysis, wherein 720 drugs were prescribed. Only 15% of drugs were prescribed by generic name, 21.67% of the total drugs consisted of fixed-dose combinations, only 40% of drugs were from the Essential drug list of Nepal and 29.44% (n=212) were from the WHO Essential drug list. It was found that more than half (54.17 %) of the drugs were from Nepalese National Formulary and 35.69% were from WHO model formulary. Dermatological products were most commonly prescribed followed by drugs acting on central nervous system, antimicrobials and drugs acting on cardiovascular system. Among the drugs dispensed, 79.16% were oral followed by topical (18.19%) and parenteral forms (2.98%). Diagnosis was mentioned only in 3.23% (n=8) of the prescriptions and the average cost per prescription was found to be 241.11 Nepalese rupees (US$ 3.26). It was found out that pharmacist labelled only 0.4% of the medication envelopes with the name of the patient. However, 82.6% of the medication envelopes were labelled with name of the drug and 87.0 % with drug strength. Only 53.8% (n=133) of the patient knew both the duration of the therapy and administration time of drugs. Conclusion: There is a need for educational intervention for prescribers and both managerial and educational intervention for the hospital pharmacists to improve prescribing and dispensing. Key words: Rational use of drugs, Dispensing, Pharmacist, PrescribingPublication Consumption of rodenticides by humans(Institute of Medicine, 2007) Kishore, PV; Palaian, S; Prabhu, M; Mishra, PAbstract Case report: Poisoning is a common problem worldwide. Among the various poisonings, rat poison accounts for a significant number of cases. The common rat poisons are anticoagulant containing (superwarfarins) and phosphide containing. In case of superwarfin poisoning, the major symptom is increased prothrombin time and the management is directed towards coagulation. In case of phosphide containing, the symptoms are non-specific and the patient should be managed symptomatically. We present three case vignettes of rat poisoning cases treated at our hospital. Since rat poisoning is a common problem, the hospitals should also develop standard treatment guidelines regarding the management of rat poisoning. One should also make the differential diagnosis of the poisoning based on the type of rat poison prior to the management. Keywords: Superwarfarin, prothrombin, RodenticidePublication Drug induced hepatitis with anti-tubercular chemotherapy: Challenges and difficulties in treatment(Kathmandu University, 2007) Kishore, PV; Palaian, S; Paudel, R; Mishra, P; Prabhu, M; Shankar, PRTuberculosis is a major health burden worldwide. In Nepal, it is a significant cause of morbidity and mortality. Although better drugs are available for managing tuberculosis, treatment failure is one of the common problems encountered. Among the various causes which can cause treatment interruption, drug induced hepatotoxicity is a common cause. Isoniazid and Pyrazinamide are the common drugs causing hepatotoxicity. Upon occurrence of hepatotoxicity, the hepatotoxic drugs should be stopped and reintroduced as per the available guidelines. The healthcare professional should also counsel the patients for recognizing the early symptoms due to hepatotoxicity which could prevent morbidity. Key words: Adverse effects, Hepatotoxicity, Tuberculosis.Publication Fixed drug eruption due to co-trimoxazole: a case report(Institute of Medicine, 2006) Dwari, BC; Bajracharya, S; Gupta, S; Mishra, P; Palaian, S; Alam, K; Palaian, S; Prabhu, MAbstract Background: Cotrimoxazole is a synergistic fixed dose combination of sulfamethoxazole and trimethoprim used in treatment of several infections including urinary, respiratory, gastrointestinal tract infections. Because of its wide spectrum and low cost it is one of the most preferred antimicrobial in Nepal. Fixed drug eruptions (FDEs) are drug rashes which tend to occur at the same site in the particular patient each time when an offending drug is administered. Co-trimoxazole is a drug commonly implicated for causing FDEs. Case report: We report a case of FDE due to co-trimoxazole occurred in a patient for whom it was prescribed by a local practitioner without taking adequate medication history. We also carried out the causality, severity, preventability and predictability as well as the economic impact of the associated adverse drug reaction (ADR). The report suggests that before prescribing any drug, clinicians should take appropriate medication history and upon occurrence of any ADR the patient should be counseled and instructed to communicate with the clinicians wherever they attend for the next time. Keywords: Causality assessment, Co-trimoxazole, Fixed drug eruption, Naranjo algorithmPublication Therapeutic dimensions of ACE inhibitors- A review of literature and clinical trials(Kathmandu University, 2005) Prabhu, M; Palaian, S; Malhotra, A; Ravishankar, P; Bista, D; Almeida, R; Mishra, PIn the 1970s, pharmacological therapy interrupting the renin-angiotensin system was considered beneficial for patients with high-renin hypertension. This gave rise to the development of ACE inhibitors. Surprisingly, the ACE inhibitors proved to be effective not only in patients with high renin hypertension, but also in many patients with normal levels of plasma renin activity. At present ACE inhibitors have a significant position in a wide range of chronic illnesses such as atherosclerosis, hypertension, myocardial infarction, diabetic complications, stroke etc. They are combined safely with drugs like angiotensin receptor blockers, calcium channel blockers and thiazides with varying degree of benefits. Though they are safe drugs, patients need monitoring for renal insufficiency, hypotension, hyperkalemia etc. The safety of these drugs in paediatrics patients is not established. It is better to avoid these drugs during pregnancy. Keywords: ACE inhibitors, Atherosclerosis, Diabetic complications, Hypertension, Myocardial infarctionPublication Why treat? Better prevent: Adult immunization(Kathmandu University, 2008) Kishore, PV; Palaian, S; Paudel, R; Paudel, B; Mishra, P; Prabhu, MAbstract Immunization is a safe, effective and simple way to prevent life threatening illnesses not only in children but also in adults. Vaccines are some of the safest medicines available which can relieve suffering costs related to these preventable diseases. The reason for underutilization of vaccines in adults are 1) Low prioritization of the importance of vaccines preventable diseases among adults 2) Uncertainty or lack of knowledge about the safety and efficacy 3) Lack of universal recommendations for all adults and 4) Financial constraints, especially in developing countries. Adult immunizations are administered in primary series like previously immunized, booster doses and periodic doses. Agents include Toxoids (Diphtheria and Tetanus), Live Virus Vaccines (Measles, Mumps and Rubella), and inactivated virus vaccines (Influenza), Inactive viral particles (Hepatitis B), inactivated bacterial polysaccharide vaccine (Pneumococcal) and Conjugate / Polysaccharide vaccine (Meningococcal). And also vaccines like Hepatitis A, Polio and Varicella may be recommended in some. Since the economy and literacy rate has shown a steady rise in the South Asia and people are being aware of different health problems through the recently advanced global communication, the education and awareness for immunization not only in children but also in adults need a special consideration. Keeping in view the statistical data of suffering costs related to the non-utilization of immunization in adults, the need of hour has come for utilization of immunization to emphasize its importance. Key words: Adult immunization, Vaccines.Publication Yellowish discoloration of teeth and nails during oral iron therapy in a pregnant woman(Institute of Medicine, 2010) Pai, R; Palaian, S; Prabhu, S; Prabhu, M; Mishra, PAbstract Abstract: A 27 year old pregnant woman was prescribed conventional oral iron tablets from second trimester of pregnancy. She developed gastrointestinal symptoms within 1-2 days. Following these symptoms, Iron tablets were stopped and the patient was started with iron capsule. The patient tolerated this preparation well and after 6 months she developed yellowish discoloration of the teeth and nails. Iron treatment was suspected for the discolorations and the drug was stopped. Upon stopping the therapy the discoloration vanished and teeth and nails returned to the pre treatment condition. The causality assessment and the severity assessments were carried out as per the Naranjo and Hartwig scales respectively. Since Iron treatment during pregnancy is common, this adverse drug reaction warrants monitoring. Keywords: Iron, nail discoloration, pregnancy, teeth discoloration